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Gadolinium Aspiration Following Inadvertent Endotracheal Tube Cuff Injection in a Pediatric Patient
Ahmed Mamdouh Taha Mostafa1, Muhammed Ershad2, Maricel Dela Cruz2
1Division of Medical Toxicology, Department of Emergency Medicine, Drexel University College of Medicine, 245 N. 15th St., Mail Stop #1011, Philadelphia, PA, 19102, USA. amt.mostafa@gmail.com.
Insights
Inadvertent injection of gadolinium-based contrast agents (GBCA) into an endotracheal tube cuff in a pediatric patient caused no acute complications. This case highlights the potential risks of GBCA administration and the need for careful monitoring.
Area of Science:
- Radiology and Medical Imaging
- Pediatric Critical Care
- Pharmacovigilance
Background:
- Gadolinium-based contrast agents (GBCAs) are widely used in MRI scans to enhance image quality.
- Adverse effects from parenteral GBCA exposure can range from mild to life-threatening.
- Gadolinium deposition is suspected in various adverse effects, yet management strategies lack scientific guidance.
Observation:
- A 12-year-old female with multiple comorbidities received an inadvertent intratracheal injection of 10 mL gadoterate meglumine into the endotracheal tube cuff pilot line during a sedated MRI.
- The patient was intubated and admitted to the ICU for monitoring of pulmonary injury or gadolinium toxicity.
- The patient was successfully extubated 24 hours post-procedure without any immediate complications.
Findings:
- This case of pulmonary aspiration due to inadvertent GBCA injection in a pediatric patient showed no acute side effects or complications within 24 hours.
- The long-term effects of gadolinium deposition remain a concern, as predicting future adverse events is challenging.
Implications:
- This case underscores the importance of meticulous administration protocols for GBCAs, especially in pediatric patients.
- Further research is needed to understand the long-term implications of accidental intratracheal GBCA exposure and to develop evidence-based management guidelines.
- Enhanced vigilance and standardized procedures are crucial to mitigate risks associated with GBCA administration in sensitive patient populations.
Introduction:
Gadolinium-based contrast agents (GBCA) are frequently used for MRI contrast studies. We report a case of pulmonary aspiration secondary to inadvertent GBCA injection.
Case Report:
A 12-year-old female with a past medical history significant for mitochondrial disorder, bronchial asthma, autism, recurrent urinary tract infection, epilepsy, developmental delay, dysautonomia, and thrombocytopenia was scheduled for a contrast-enhanced MRI study using gadoterate meglumine for urinary incontinence. The patient was sedated and intubated in preparation for the study, during which 10 mL of gadoterate meglumine was inadvertently injected into the endotracheal tube cuff pilot line instead of intravenously. The patient remained intubated and was admitted to the intensive care unit with continuous monitoring for signs of pulmonary injury or gadolinium toxicity. She was successfully extubated approximately 24 hours later without complication.
Discussion:
A variety of adverse effects attributable to parenteral GBCA exposure have been reported ranging from mild irritation to life-threatening anaphylaxis. Gadolinium deposition and storage have been implicated in a number of those adverse effects and multiple treatments modalities have been suggested, but no scientifically guided management exists.
Conclusion:
This case of pulmonary aspiration secondary to inadvertent GBCA injection in a pediatric patient demonstrated no acute side effects or complications within the first 24 hours. With the wide range of adverse effects attributed to gadolinium use in the medical literature, it is difficult to predict potential future adverse effects.
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